This application requests funding to complete an ongoing pilot study on the efficacy of a cognitive-behavioral, anger control training (ACT) in 42 adolescents with Tourette Syndrome (TS) and explosive, disruptive behavior. ACT will be compared to treatment as usual in a randomized clinical trial. Disruptive behaviors in TS may take numerous forms including noncompliance, anger outbursts, and physical aggression. Anger outbursts in TS have been described as rage attacks or rage storms due to their high intensity and unpredictability in response to minimal provocation. Whether these behaviors are part of TS, related to comorbid conditions, or due to the burden of chronic illness is not clear. Nevertheless, these disruptive behaviors can result in significant functional impairment and often require clinical attention. The purpose of this ACT intervention is to improve the explosive and noncompliant behavior in adolescents with TS by enhancing affect regulation and social problem-solving skills. The treatment is based on anger control training (Feindler and Ecton, 1986) which has been empirically supported for reducing aggressive behaviors and improving social functioning in aggressive youths. Funded by a one-year research award from the Tourette Syndrome Association (TSA), our research group has modified the treatment manual to target conduct problems that occur in TS. Thus far, we enrolled 15 subjects. The requested funding will allow us to continue the study, which will be the first to evaluate the efficacy of structured, cognitive-behavioral therapy for disruptive behavior problems in TS. The study will be conducted at the Yale Child Study Center in collaboration with the Tic Disorder Clinic, the ongoing Program Project in Tourette syndrome (PO1MH49351) and the Research Unit in Pediatric Psychopharmacology (NO1MH7009). The primary outcome measures include the Oppositional Defiant Scale and the Clinicians Global Improvement Score, to be assessed by a clinician blind to treatment assignment. In addition, the impact of ACT on adolescent's tic symptoms, anger experience, and family functioning will be explored. Subjects in the treatment as usual comparison condition participate in ACT after the 10-week period. This design will permit demonstration of a clinically relevant effect size for anger control training in adolescents with TS.